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Duration/Elimination: Please Select   5Yr / 90day 5Yr / 180day SSNRA / 90day SSNRA / 180day    Rate Table
Industry Code(SIC): [Find my code]

The industry you have selected is not eligible for STD or LTD coverage. View our list of ineligible industries. Please choose primary industry AGRICULTURE/FORESTRY/FISHING MINING CONSTRUCTION MANUFACTURING TRANSPORTATION/COMMUNICATION/UTILITY   WHOLESALE: DURABLE & NONDURABLE RETAIL TRADE FINANCE/INSURANCE/REAL ESTATE SERVICE GOVERNMENT Please choose sub industry Please choose industry

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Group Term Life/AD&D

Group Term Life/Accidental Death & Dismemberment (AD&D) Participation Requirements
2 to 4 lives: 100%. 5 to 7 lives: all but 1 must enroll. 8 to 9 lives: all but 2 must enroll.
Group Term Life/Accidental Death & Dismemberment (AD&D) Reductions and Termination
Benefits reduce to 65% of the original amount at age 65, to 50% of the original amount at age 70, and to 25% of the original amount at age 75.
All benefits terminate at retirement.
AD&D Limitations
Benefits will not be paid for a loss caused directly or indirectly by:

• disease, bodily or mental infirmity, or infection (except bacterial infection of a visible injury)
• suicide or intentionally self-inflicted injury, whether sane or insane
• participation in a riot or insurrection, or commission of an assault or felony
• war or any act of war, declared or undeclared
• use of any drug, hallucinogen, controlled substance, or narcotic unless prescribed by a physician
• travel or flight in, or descent from, any aircraft unless as a fare paying passenger on a commercial airline flying between established airports on: (a) a scheduled route, or (b) charter flight
• participation in parachute or hang gliding sports, or an organized race or speed contest

Short Term Disability (STD)

Additional STD eligibility requirements:

1. Groups with less than 61% of employees age 50 and above;
2. Groups with less than 51% of those covered being from same family. "Family" means father/in-law, mother/in-law, sister/in-law, brother/in-law, son/in-law, or daughter/in-law.

STD Termination Benefits terminate at retirement. STD Limitations Benefits will not be paid for total disability caused by or related to:

• injury arising out of or in the course of any occupation or employment for pay or profit, or any injury or sickness for which the insured is entitled to benefits under any Worker's Compensation Law, Employer's Liability Law or similar law
• injury or sickness resulting from war or any act of war, declared or undeclared
• employee's participation in a riot or insurrection, or commission of an assault or a felony
• attempted suicide or intentionally self-inflicted injury
• employee's use of alcohol, any drug, hallucinogen, controlled substance, or narcotic unless prescribed by a physician
• elective or cosmetic surgery, except for surgery to repair damage to the natural body caused by injury

Long Term Disability (LTD)

Amount of insurance is 60 percent of monthly salary, maximum of $4,000, $5,000, or $6,000. Additional LTD eligibility requirements:

1. Groups with less than 61% of employees age 50 and above;
2. Groups with less than 51% of those covered being from same family. "Family" means father/in-law, mother/in-law, sister/in-law, brother/in-law, son/in-law, or daughter/in-law.

LTD Exclusions: No benefit shall be paid for any disability:

• unless the insured employee is under the regular care of a physician
• that is caused or contributed to by war or act of war, declared or not
• caused by an insured employee's commission of or attempt to commit a felony, or to which a contributing cause was his being engaged in an illegal occupation
• caused or contributed to by an intentionally self-inflicted injury
• due to or contributed to by, or results from a Pre-Existing Condition

If you are receiving or are eligible to receive benefits for a Disability under a prior disability plan that:

• was sponsored by the Employer; and
• was terminated before the Effective Date of this plan,

no benefits will be payable for that Disability under this plan. Guarantee Issue: Maximum Guarantee Issue is $4,000.

General Conditions

• An employee must be actively at work on his proposed effective date of coverage, or his coverage will not become effective until he returns to active work.
• If a dependent is totally disabled on his proposed effective date of coverage, the coverage will not become effective until the dependent has fully recovered from the condition causing the disability.
• Evidence of Insurability (EOI) is required on Group Term Life, AD&D, and LTD amounts in excess of the Guarantee Issue amounts on all late applications for contributory coverage.
• Employer must contribute at least 25% of cost.

Eligibility

• All full-time employees who work a minimum of 30 hours per week on a year-round basis. Coverage does not include temporary, seasonal, or retired employees.